In the United States, article processing charges for orthopaedic journals can be excessive and may offer a poor cost-to-benefit ratio regarding article engagement. This study hypothesizes that article processing charges will not strongly correlate with metrics of engagement such as citations, regardless of publication model. The Journal Citation Reports (Clarivate, Philadelphia, PA) identified 136 orthopaedic journals, of which 83 were non-United States journals and six were not suitable for analysis, resulting in 47 journals for analysis. The collected variables included access options, article processing charge, publisher, impact factor with and without self-citations, immediacy index, normalized Eigenfactor (journal influence), article influence score, total citations, total articles, citations per open access article, and citations per restricted and free article. T- and Chi-square tests statistically compared continuous and categorical variables, respectively, and significance was determined at p < 0.05. Linear regressions computed a coefficient of determination to assess any correlation between cost and metrics of engagement, with strong correlation assessed at ≥ 0.80. Publishing unrestricted open access was significantly more expensive in hybrid journals. Hybrid journals received significantly more total citations than open access, however, no difference between hybrid or open access journals was noted when comparing citations per article within 3 years. No other differences or correlations were found in engagement metrics, publication models, or cost. Access and incorporation of novel findings into clinical practice may depend on scientific publishing practices and, specifically, our ability to maximize viewership while maintaining cost-effectiveness.